Sleep-related deaths are a common preventable cause of death, and such deaths occur disproportionately in families of color. Home visitors provide families with education about infant safe sleep guidelines; however, families face many barriers to engaging in safe sleep practices. This study evaluated the efficacy of a program to train home visitors to talk to clients about infant safe sleep using Motivational Interviewing and cultural sensitivity. We examined the effects of the intervention on home visitors’ (n = 23) knowledge, MI skill use, and cultural sensitivity using a single group pre-post design. We also examined home visiting clients’ (n = 78) knowledge, attitudes, and behaviors using a quasi-experimental design. Home visitors were primarily female (97%), had a college degree (86%), and were primarily white (50%) or African American (43%). The home visiting clients were all female and were primarily African American (43%) and Caucasian (36%). Most clients (59%) earned less than 30,000 dollars per year. Home visitors showed significant improvement in MI skill use and cultural sensitivity from pre- to post-test. Regarding client outcomes, our results indicate a significant group by time interaction when predicting changes in client knowledge such that the treatment group showed larger gains than the control group. There were no significant differences between groups when predicting changes in client attitudes or behavior. MI may be an effective technique for home visitors to help increase families’ safe sleep knowledge. Additional research is needed to examine whether such training can translate to changes in families’ safe sleep behavior.
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American Academy of Pediatrics. (2016). American academy of pediatrics announces new safe sleep recommendations to protect against sids, sleep-related infant deaths. Retrieved April 29, 2020, from https://www.aap.org/en-us/about-the-aap/aap-press-room/pages/american-academy-of-pediatrics-announces-new-safe-sleep-recommendations-to-protect-against-sids.aspx
Anzaldua, G. (1987). Borderlands/la frontera: The New Mestiza (Vol. 3). Aunt Lute Books.
Beach, M. C., Price, E. G., Gary, T. L., Robinson, K. A., Gozu, A. W., Palacio, A. B., et al. (2005). Cultural competence: A systematic review of health care provider educational interventions. Medical Care, 43, 356–373.
Burke, B. L., Arkowitz, H., & Menchola, M. (2003). The efficacy of motivational interviewing: A meta-analysis of controlled clinical trials. Journal of Counseling and Clinical Psychology, 71, 843–861.
Center for Disease Control. (2016). Infant Mortality. Retrieved April 26, 2020, from https://www.cdc.gov/reproductivehealth/maternalinfanthealth/infantmortality.htm
Center for Disease Control. (2017). Sudden unexpected infant death and sudden infant death syndrome. Retrieved from https://www.cdc.gov/sids/data.htm
Cole, E. M., Piercy, F., Wolfe, E. W., & West, J. M. (2014). Development of the multicultural therapy competency inventory-client version. Contemporary Family Therapy, 36, 462–473.
Fowler, A. J., Evans, P. W., Etchegaray, J. M., Ottenbacher, A., & Arnold, C. (2013). Safe sleep practice and sudden infant death syndrome risk reduction. Clinical Pediatrics, 52, 1044–1053.
Gaydos, L. M., Blake, S. C., Gazmararian, J. A., Woodruff, W., Thompson, W. W., & Dalmida, S. G. (2015). Revisiting safe sleep recommendations for African-american infants: Why current counseling is different. Maternal and Child Health Journal, 19, 496–503.
Herman, S., Adkins, M., & Moon, R. Y. (2015). Knowledge, and beliefs of African American and American Indian parents and supporters about infant safe sleep. Journal of Community Health, 40, 12–19.
Jernigan, V. B. B., Hearod, J. B., Tran, K., Norris, K. C., & Buchwald, D. (2016). An examination of cultural competence training in US medical education guided by the tool for assessing cultural competence training. Journal of Health Disparities Research and Practice, 9, 150–167.
Lundahl, B. W., Kunz, C., Brownell, C., Tollefson, D., & Burke, B. L. (2010). A meta-analysis of motivational interviewing: Twenty-five years of empirical studies. Research on Social Work Practice, 20, 137–160.
Martins, R., & McNeil, D. W. (2009). Review of motivational interviewing in promoting health behaviors. Clinical Psychology Review, 29, 283–293.
Michigan Department of Health and Human Services. (2019). Sleep Related Deaths in Kalamazoo Country [Fact sheet]. Retrieved April 28, 2020, from http://keepingkidsalive.org/data-publications/child_mortality_data/fact_sheets/Kalamazoo_FactSheet_2010-2015.pdf
Mitchell, E. A. (2009). Review SIDS: Past, present, future. Acta Paediatrica, 98, 1712–1719.
Moyers, T. B., Rowell, L. N., Manuel, J. K., Ernst, D., & Houck, J. M. (2016). The motivational interviewing treatment integrity code (MITI 4.2) rationale, preliminary reliability, and validity. Journal of Substance Abuse Treatment, 65, 36–42.
National Home Visiting Resource Center. (2018). Home Visiting Yearbook. Retrieved April 15, 2020, from https://www.nhvrc.org/wp-content/uploads/NHVRC_Yearbook_2018_FINAL.pdf
National Institute for Children’s Health Quality. (2020). States use home visiting programs to spread safe sleep messages. National Institute for Children’s Health Quality.
National Institute of Child Health and Human Development. (2016). Safe to sleep. Retrieved April 9, 2020, from https://safetosleep.nichd.nih.gov
Ospina, F., & Hill, E. (2020). Increasing cultural competency and reducing victim-blaming through antiracism workshops. In Accepted for presentation at the 38th Annual Kalamazoo Community Medical and Health Sciences Research Day at Western Michigan University Homer Stryker M.D. School of Medicine. (Cancelled due to Covid-19).
Owens, M. D., Rowell, L. N., & Moyers, T. (2017). Psychometric properties of the motivational interviewing treatment integrity coding system 4.2 with jail inmates. Addictive Behaviors, 73, 48–52.
Pace, B. T., Dembe, A., Soma, C. S., Baldwin, S. A., Atkins, D. C., & Imel, Z. E. (2017). A multivariate meta-analysis of motivational interviewing process and outcome. Psychology of Addictive Behaviors, 31, 524–533.
Parsons, J. T., Lelutiu-Weinberger, C., Botsko, M., & Golub, S. A. (2014). A randomized controlled trial utilizing motivational interviewing to reduce HIV risk and drug use in young gay and bisexual men. Journal of Counseling and Clinical Psychology, 82, 9–18.
Prochaska, J. O., Norcorss, J. C., & Diclemente, C. C. (2013). Applying the stages of change. Psychotherapy in Australia, 19, 10–15.
Smith, O. E., Heckmeyer, C. M., Kratt, P. P., & Mason, D. A. (1997). Motivational interviewing to help improve adherence to a behavioral weight control program for older obese women. Diabetes Care, 20, 52–54.
United Health Foundation. (2016). Infant Mortality. Health of Women and Children. America’s Health Rankings. United Health Foundation.
West, A., Gagliardi, L., Gatewood, A., Higman, S., Daniels, J., Neil, K. O., & Duggan, A. (2018). Randomized trial of a training program to improve home visitor communication around sensitive topics. Maternal and Child Health Journal, 22, 70.
Zoucha, R., Walters, C. A., Colbert, A. M., Carlins, E., & Smith, E. (2015). Exploring safe sleep and sids risk perception in an African-american community: Focused ethnography. Public Health Nursing, 33, 206–213.
This work was supported by the United Way of the Battle Creek and Kalamazoo Region (P.I. Cheryl Dickson, M.D., MPH).
Conflict of interest
Summer Chahin, Amy Damashek, Fernando Ospina, and Cheryl Dickson declare that they have no conflict of interest.
Human and Animal Rights and Informed Consent
All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2000 (5). Informed consent was obtained from all patients for being included in the study. All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2000 (5). Informed consent was obtained from all patients for being included in the study.
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Chahin, S., Damashek, A., Ospina, F. et al. Evaluation of a Safe Sleep Training for Home Visitors and Their Clients. J Clin Psychol Med Settings 29, 477–488 (2022). https://doi.org/10.1007/s10880-021-09811-2
- Infant mortality
- Infant safe sleep
- Home visiting services
- Motivational interviewing